Rheumatology

Question 1

Sx of Lupus

Answer 1

“SOAP BRAIN MD”

Serositis (pleuritic CP)

Oral Ulcers

Arthritis (poly)

Photosensitivity

Blood (Anemia, Thrombocytopenia)

Renal (Lupus Nephritis, can cause RF)

ANA

Inflammatory Markers (any others)

Neuro (Cerebritis, looks like meningitis)

Malar Rash

Discoid Rash

***Need 4 of 11 for Lupus Dx

Question 2

Dx and Tx of Lupus Flair

Answer 2

Dx:

• Complement levels = Decreased
• (Increased in Infxn)

Tx:

• Steroids (prednisone)

Question 3

Follow-up Labs for Lupus Pt

Answer 3

BUN/Creatinine

U/A

(Screen for Lupus Nephritis)

Question 4

Dx and Tx Lupus Nephritis

Answer 4

Dx:

• Renal biopsy

Tx:

• IV Cyclophosphamide (acute)
• PO Mycophenolate mofetil

Question 5

Tx of Lupus

Answer 5

• NSAIDS = treat sxs
• Hydroxychloroquine = prevent flairs

Question 6

Tx of Lupus Flair

Answer 6

Prednisone

Question 7

Drugs that cause Drug-induced Lupus

Answer 7

SHIPP

• Sulfonamide
• Hydralazine
• Isoniazid
• Phenytoin
• Procainamide

Question 8

Joint pain + Spine involvement (C1, C2)

Answer 8

RA

Question 9

Joint pain + Spine involvement (lumbar)

Answer 9

Ankylosing Spondylitis

Question 10

Malar rash + Renal Failure in healthy female

Answer 10

Lupus

Question 11

Malar rash + Hx miscarriages

Answer 11

Lupus

Question 12

Malar rash + Verricous vegetations on mitral valve

Answer 12

Libman-Sacks endocarditis 2/2 Lupus

Question 13

Felty Syndrome

Answer 13

RA + Neutropenia + Splenomegaly

Question 14

Joint pain in small joints; X-ray shows “Periarticular osteopenia”

Answer 14

RA

Question 15

RA Sx

Answer 15

“Nobody Should Have Rheumatoid Symptoms 3 times (X)”

• Nodules (Cholesterol on Bx)
• Symmetric
• Hands
• RF or CCP
• Stiffness (worse in morning, lasts >60 min)
• 3 or more joints, spares DIP
• X-ray shows erosions

Question 16

Tx: RA

Answer 16

• 1st line: Methotrexate (everyone)
• 2nd line: Leflunomide
• Pregnant = Hydroxychloroquine
• NSAIDS (Added for sx relief)
• Biologics (Etanercept, Infliximab, Rituximab, other TNF-alpha inhibitors) (Severe)

Question 17

Vasculitis + Hep B

Answer 17

Polyarteritis Nodosa

Dx: Angiogram - aneurysms and stenosis of medium vessels

Tx: Steroids + Cyclophosphomide

Question 18

Palpable Purpura + Hep C

Answer 18

Cryoglobulinemia

Dx: Serum - cryoglobulins + decreased complement

Tx: Tx Hep C, Steroids + Cyclophosphamide; Plasmaphoresis if severe

Question 19

Vasculitis/Purpura after URI/Pharyngitis

Answer 19

Henoch-Schonlein purpura

Dx: Bx - leukocytoclastic vasculitis

Tx: Steroids

Question 20

Pt w/ unilateral HA and tender swollen temporal artery. Next step?

Answer 20

Give steroids!!! Then can make definitive dx w/ biopsy

Question 21

Hemoptysis + Hematuria + Chronic sinusitis

Answer 21

Granulomatosis with Polyangiitis

Dx: c-ANCA; Bx - vasculitis and necrotizing granulomas

Tx: Steroids and Cyclophosphamide

Question 22

Hemoptysis + Hematuria + Asthma

Answer 22

Churg Strauss (Eosinophilic Granulomatosis w/ Polyangiitis)

Dx: P-ANCA; Eosinophilia

Tx: Steroids + Cyclophosphamide

Question 23

Hemoptysis + Hematuria + palpable purpura

Answer 23

Microscopic Polyangiitis

Dx: P-ANCA

Question 24

Absent pulses in upper extremities, increased ESR, fever

Answer 24

Takayasu Arteritis

Dx: Angiogram

Tx: Steroids (High dose prednisone)